One Clinic Is Promising to Cut the Cost of Egg Freezing in Half

When it first became possible to preserve a human oocyte in the 1980s, it seemed, for a moment, as though it might soon be possible to precision-schedule pregnancy around your career. Or your hobbies. Babies on demand. But it quickly became clear that this option was open only to a sliver of the wealthiest people—often those least in need of the flexibility afforded by egg freezing. Even today the process usually costs between $10,000 and $15,000.

Only in recent years has egg freezing begun to be democratized, especially as employers like Facebook, Google, and Apple have offered to cover that bill. Demand for frozen eggs spiked, and the idea went from niche to near-mainstream. One fertility clinic, EggBanxx, has projected that in 2018, around 76,000 people will freeze their eggs.

With that demand comes new providers and new questions—about corporate decimation of the human lifecycle, and about a culture that puts too much emphasis on work and too little on human connection. Egg freezing has been decried as less of an empowering option than requisite incursion of risk and cost onto women in competitive industries. But how much of this would be an issue if it were radically less expensive, and if outcomes were closer to guaranteed?

That’s what intrigued me about a new clinic called Extend Fertility. Having just opened its doors in midtown Manhattan, Extend is advertising an “all-inclusive” price of $4,990. If you’re healthy and young enough to undergo the process, the doctors promise a dozen frozen eggs for that price. As in, even if the team has to repeat the procedure three or four times, you will get your eggs. (Limits of human physiology apply.)

That is a novel idea in American health care, where clinics charge by the procedure (fee for service) as opposed to charging by the outcome. A model for this in medicine has been LASIK eye surgery, where competitive markets have forced ophthalmologists to guarantee that they can improve your vision—and, if not, will repeat the procedure at no cost.

How could it be, though, that a chic clinic in Manhattan would be able to cut the cost of this procedure in half? If that’s right, this is a model that might be considered for many other areas of health care. So I visited Extend Fertility in this week’s episode of If Our Bodies Could Talk. The clinic feels like a spa with a phlebotomy room and ultrasound machines:

As with any four-minute video about an enormously complex topic, there’s more to the story.

It turned out that the cost is definitely not “all-inclusive.” That’s a serious problem in their story, and one that I only found by digging through their pricing scheme.

When I had asked the chief medical officer, Josh Klein, how he cut the cost in half, he said it was super-specialization and economies of scale. By only doing one thing, the clinic can do it much more cheaply. He cited LASIK, too. There are entire clinics that only perform LASIK, and by doing that, they eliminate overhead costs of running a general ophthalmology practice.

There are similar fertility clinics, like EggBanxx, but they specialize in egg freezing and in-vitro fertilization (as well as horrible names). Extend Fertility is unique in that it does only egg retrieval—it does not fertilize and implant the egg into a uterus.

But even with that level of specialization, the actual answer on how you cut the cost in half is that you don’t. At least, not yet. At Extend, hormone treatments are not included in the cost, and they are not cheap—often between $2,000 and $4,000. The procedure is impossible without those treatments, so by any definition of “all-inclusive,” these should be included.

And then there is storage of the eggs (at a facility in Boston), which costs another $2,000 for five years or $3,500 for ten. This is also a necessary cost—unless you plan to have eggs retrieved and immediately used for IVF, which is not the advertised purpose of the company. Again, an inclusive cost would include at least some freezing time.

After factoring in these costs, it’s possible that a person could choose Extend Fertility and not save any money. Though as the practice grows, Klein hopes the price points can drop further. After training at Massachusetts General Hospital and New York-Presbyterian Columbia University Medical Center, where exorbitant costs are opaque and often totally removed from medical decision-making, Klein sees steps toward price transparency and cost savings as progress.

Super-specialization also stands to improve safety and quality for patients. The enormous hospitals that Klein once called home tend to offer every imaginable service under one roof. That sometimes leads to a situation that is a little like a restaurant that has spaghetti, sushi, and steak. Somehow in medical care, we tend to think that’s good.

If I were going to have my corneas shaved, or my hip replaced, or my eggs frozen, I’d want it done by the person who does these things all day every day. Klein has done thousands of cases. That’s valuable because while the process is relatively straightforward, as medical procedures go, it’s not without risk. The actual retrieval takes 20 minutes and can be done while a person is partially conscious— all that is required is a steady hand that can hit an ovarian follicle with a needle.

Complications are not uncommon, though, during the days surrounding the procedure. For about 10 days prior to the retrieval, a patient needs to take the aforementioned (expensive) hormones that cause the ovaries to grow follicles full of eggs. These are analogs of the hormones that female bodies produce on their own, but in high doses a person can develop Ovarian Hyperstimulation Syndrome. Nurse-practitioner Dayna Hennessy, director of clinical operations at Extend, said that tends to manifest as bloating and pain, like a severe nadir in a menstrual cycle (which is what she’s inducing endocrinologically.)

And while the guaranteed-egg outcome is a unique idea, Klein is carefully guarded when he talks about expectations for pregnancy. The eerie motto of Extend Fertility is “Preserve your options”—ripped straight from some science-fictional imagining of a world where we have absolute control of our physiology. In reality, even if you have a dozen eggs frozen, the chance that an egg can be successfully implanted and lead to a pregnancy after age 38 or so drops sharply.

Though the procedure is still new enough that long-term risks are not yet known, frozen eggs don’t appear to pose any unique risks during pregnancy, and studies have not found an increased risk of birth defects. The oldest people born of IVF pregnancies are now in their 20s, and apart from being Millennials, they appear to be doing fine.

In 2012, the American Society of Reproductive Medicine removed the “experimental” designation from egg freezing, thereby deeming the process to be generally safe and effective. But the society did not explicitly endorse the procedure for healthy women who simply want to preserve their options. (The guidelines read: “There are not yet sufficient data to recommend oocyte cryopreservation for the sole purpose of circumventing reproductive aging … ”)

This is all to say that I’m not endorsing or warning against egg freezing, just hoping to make the process a little more transparent as these new businesses spring up.

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